1538565783 NPI number — MR. JEFFREY D. HANLEY IL.2474 BC-HIS 6946

Table of content: MR. JEFFREY D. HANLEY IL.2474 BC-HIS 6946 (NPI 1538565783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538565783 NPI number — MR. JEFFREY D. HANLEY IL.2474 BC-HIS 6946

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANLEY
Provider First Name:
JEFFREY
Provider Middle Name:
D.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IL.2474 BC-HIS 6946
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538565783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
733 N. LOGAN #4
Provider Second Line Business Mailing Address:
AUDIBEL HEARING AIDS
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-442-1900
Provider Business Mailing Address Fax Number:
217-442-1765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 S. STATE STREET
Provider Second Line Business Practice Location Address:
AUDIBEL HEARING AIDS
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-762-2155
Provider Business Practice Location Address Fax Number:
217-762-9062
Provider Enumeration Date:
11/17/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  2474 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)